Combined effect of the dietary antioxidant quality score and physical activity (metabolic equivalent of task) on heart failure: a cross-sectional study based on the NHANES 2007–2020

Diet and physical activity (PA) may influence the development of heart failure (HF). However, evidence regarding their combined effects on HF remains limited. Accordingly, this study endeavors to unveil the joint association of the Dietary Antioxidant Quality Score (DAQS) and PA with the odds of HF. This cross-sectional study (CSS) included participants aged ≥ 20 from the NHANES 2007–2020 database. Weighted logistic regression models were employed to examine the associations of DAQS and PA with HF, as well as their combined effect, in U.S. adults. Subgroup analyses were additionally performed. 27,781 participants were included, comprising 888 individuals in the HF group and 26,893 in the non-HF group. In the fully adjusted model, a higher DAQS was significantly associated with a lower HF risk compared with a low DAQS (odds ratio (OR) [95% confidence interval (CI)] 0.73 [0.56–0.96], P = 0.027). Relative to low-intensity PA, high-intensity PA was likewise inversely associated with the odds of HF (OR [95% CI] 0.67 [0.51–0.88], P = 0.004). On the additive scale, the joint effect of the two factors was more strongly associated with a lower HF risk than either factor alone (relative excess risk due to interaction (RERI) = 0.227, 95% CI 0.072–0.383). Similar results were observed in both subgroup analysis and sensitivity analysis. In the mediation analysis, BMI, diabetes, and hypertension each exerted significant mediating effects on the inverse associations of the DAQS and PA with HF. Higher DAQS levels and high levels of PA are associated with a lower HF risk, and their combined effect demonstrates a significant joint association with HF.